Media Release
FOR IMMEDIATE RELEASE

AN OPEN LETTER TO PREMIER MCGUINTY FROM THE COALITION OF FAMILY PHYSICIANS OF ONTARIO

( March 10, 2004 , Toronto , Ontario ) – Dr. Douglas Mark, President of the Coalition of Family Physicians of Ontario (COFP), announced today that the Coalition would be sending the following open letter to Premier McGuinty to all family physicians across the province of Ontario in order for them to share it with their patients. Dr. Mark also revealed that he and other representatives of the Coalition of Family Physicians of Ontario would be attending the Liberal Heritage Dinner this evening in hopes of speaking with the Premier about the crisis in family medicine.

Your government's decision to negotiate the terms of the next doctor's contract in the media is regrettable. The introduction of Bill 8 and Bill 31 makes us wonder what harm we have ever done to you or our patients to deserve this sort of treatment.

We are truly confounded and deeply troubled by your actions. We strive to provide first-class care for our patients. Your actions and those of the Minister of Health and Long-Term Care have boxed us into a corner, castigated and persecuted us and cast public aspersions that we are no longer needed within our health-care system. We do not think the people of Ontario agree with you, and we meet with them everyday in our examining rooms.

We wish to explain where these deliberate actions will lead.

Family physicians are independent contractors, subject to the same market forces and inflationary pressures regarding our office expenses and operations as any other businesses. Your government intends to change that with Bill 8. It will have a markedly negative impact on the provision of a wide range of services that Ontarians have come to expect from their family doctor.

Currently, physicians have the right to bill patients directly for a variety of uninsured (unpaid by OHIP) services such as notes, legal documents, insurance forms, and delisted medical services among others. Bill 8 will eliminate this right. This conversion of physicians into indentured quasi “employees” is summary removal of a right that other Ontarians enjoy when they deliver services to the public.

Under Bill 8, there is a failure to respect our integrity and honour. There is also an outright dismissal of our obligations to our patients. You compel physicians to enter an accountability agreement with your government without the right to accept or reject such agreements or discuss its terms. Should we reject the agreement, the consequence is that we will not be paid for our patient care services. You are effectively strong-arming physicians.

We are at a loss to understand why you would expect us to accept provisions of Bill 8 that make us accountable to your Health Minster for our only source of payment.

We are also concerned that your Health Minister and the Ministry of Health and Long-Term Care will set standards and health outcomes for care without evidence and without asking Ontario doctors if these are indeed reasonable or even possible. We are in the business of trying to promote and safeguard the health of our patients and to protect the confidentiality of medical information about them.

If we do not comply with your Health Minister's objectives that we think are driven by misguided aspirations of the inherited bureaucracy, he will dispatch compliance inspectors to our offices with the new legal right bestowed on them to enter and search our patients' medical records without a warrant, without any just cause and without providing us with due process of law. We consider this new threatened power to be a gross violation of our ability to promote our patients' health and to protect the confidentiality of our patients' medical records and information.

Why would you subject us to arbitrary rules by unaccountable officials without due process and imprisonment of up to one year and fines of up to $100,000? If we ask for a review, someone appointed by the same government official will conduct it. There are no natural justice safeguards for doctors.

The guilty-until-proven-innocent process inherent in Bill 8 is a striking violation of the most basic principles of our legal system. One need only witness the dishonourable conduct of the Medical Review Committee using the same process and the resulting destruction of honest and dedicated physicians to recognize the problems clearly.

In the context of the principles of natural justice and the principles that govern us in a democratic society, we do not understand why you and your Health Minister take offense when we refuse to accept such a system. We can be sentenced for up to 12 months in jail without the benefit of a proper hearing if the Manager of OHIP merely suspects that we may have received an unauthorized payment. We fail to see how this process promotes and protects the health of our patients.

Your Health Minister has stated categorically that we should temper our demands for increases to our gross incomes. He refers to our gross revenue, the amount before we pay 40 to 50 per cent in overhead expenses, and before we pay income tax. Our gross revenues have seen an increase of only 8.8 per cent between 1992 and 2003, well below the Cost of Living increases in the same period that approximates 35 per cent. The fact is that our net income (gross revenue less expenses) has not increased at all over the past decade. This is because the increases in the cost of operating our practices have used up any potential after expense increase for family physicians.

You know that the fees paid to us by OHIP are among the very lowest of any province in Canada . We have reached the point where we are unable to cut our practice expenses any further. The current OHIP fee structure does not respond to the realities everyone faces – inflation, tax increases, staff salary raises, increases in the cost of infrastructure and equipment improvements, etc. We need your help at this critical juncture.

We strive to provide the best possible care for our patients. Ontarians consistently rate our care and services at an “A” grade. Premier, we do not understand why your government would want to restructure the highest-rated part of public health-care system – the role of family physicians and their delivery of comprehensive care – when there are other more real and immediate problems that deserve your full attention.

We are disheartened that despite our best efforts to do our jobs well, your plans for the future marginalize our expertise and skills and pull us further away from our patients. We lament your failure to consult with the key front line workers – family doctors – as you move ahead and plan significant changes in health-care delivery in Ontario .

Premier, your government speculates without any proof that the introduction of Family Health Teams will control health-care costs and improve patient care services. We have yet to see evidence that this assertion is true. This system, like other primary care reform projects, has not been subject to rigorous audit and evaluation. It is at best unclear if it will indeed provide better service by family doctors that consistently rate an “A” grade by Ontarians.

Your Health Minister promises the people of Ontario that they will receive 24-hour per day care, seven days per week and 365 days per year, though we have not yet seen his plan for achieving this. With Bill 8, we fear that should we or our colleagues not be able to provide such onerous after-hours care, we may be sent to jail for a breech of accountability.

The Family Health Teams your government proposes will be centered on nurses, whom you intend to pay $75,000 (net) with added benefits, pensions, medical education allowance, and vacation pay for a regular 40 to 44 hour workweek. Family doctors currently earn on average about $100,000 (net) without benefits, pensions, medical education allowance or vacation pay for 60-hour work weeks. We fail to see how Family Health Teams will produce any significant savings.

Over the years, Ontario family doctors have invested one billion dollars of their own money to establish the medical infrastructure in Ontario for their patients' use. Most of us own or lease our offices, contents and equipment.

Is it your Health Minister's intention to have nurse practitioners work in our offices without appropriate funding for the additional costs to co-occupy a physician's office? Physicians cannot assume this extra cost. Alternatively, will your government spend the millions of dollars required to provide their premises and equipment?

When nurse practitioners are on their paid vacation, will the Ministry of Health and Long-Term Care provide the backup nurse practitioners to look after their patients? Will there be provision to provide locum (replacement) nurse practitioners to cover maternity or paternity leave?

With the revisions contained in Bill 8, do you intend to contractually obligate doctors to do this? Will we face the specter of jail time or financial ruin if your Health Minister decides that we must comply with an impossible patient load?

Will nurse practitioners have to sign a contract that obligates them to the same accountability and compliance rules that carry the penalty of large fines and/or jail?

Previous governments' actions have consistently eroded the civil rights of physicians through legislation. It is deeply disconcerting that your government intends to do the same by only making doctors accountable and vulnerable to severe punishment without due process.

Premier, you are aware over one million Ontarians have no family doctor. Forty per cent of family physicians are now over 50 years old. Twenty-five per cent are set to retire within the next five years. There are virtually no new graduates willing to join comprehensive care medicine as it now stands and many existing doctors are planning to leave the province or the profession altogether. Morale is at an all time low.

We believe that we both share the same goal to build a first-class health-care system here in Ontario . Unfortunately, we fear that by your Health Minister's actions, this objective will elude Ontarians. The failure to meet the expectations of the people of Ontario is not a burden we can allow family doctors to bear. We will therefore engage in a campaign to ensure that our patients know that you and your government alone are the true authors of the failures we anticipate – and of the end of comprehensive care as we know it.

Actions stemming from Bill 8 and Bill 31 will only hasten the family doctor shortage and further erode services. Within 10 years, we fear that very few patients will receive comprehensive care from a trusted physician. Instead, we foresee a swath of drop-in centers with limited resources.

The scenario in the imminent future is not encouraging. Family doctors will be so swamped with patients demanding care that they have put their office phones on hold. People will wait many hours, days or weeks to see a doctor. Family doctors will no longer able to provide appointments because he or she will not have enough funding to pay the staff to answer the telephone and book appointments. They will no longer have the time or resources to be the collator and case manager of the patients' medical records. There are too many patients and not enough time to maintain these records.

We are concerned that many of the 15,000 support staff will lose their jobs because of your government's actions. Indeed, the unemployment and social welfare payments could add up to millions of dollars per week. In addition to these costs, the cost/benefits of a system that saves money by maintaining the health status of patients through comprehensive and preventative care will be lost.

We are sure you agree that the economic benefit for foreign investors who see comprehensive health care in our publicly funded health-care system as a key incentive to locate and invest in Ontario will be lost if we continue on the present course.

This scenario reminds us of the future alternate universe stories. Sometimes all it takes is the action of one person – a specific decision or event – to change the course of history. Indeed, historians writing in the What If? series of history books speculate all too often how tenuous the fabric of our history really is. Pulling on the wrong thread can cause a cascade of events that cannot be stopped.

Premier, we do not want that tapestry to unravel. Your government is poised at a critical moment in history. Twenty-five per cent of your family doctors will retire in five years. There are not enough nurse practitioners to even remotely fill in this deficit. Newly graduated family doctors are staying away from Ontario . Medical students have little desire to become family doctors.

What your government does now will either set us on a course for recruiting, retaining and attracting new doctors to Ontario or, should your present plan proceed, leave three to five million more Ontarians without a family doctor by the time you call the next provincial election. Once they are gone, they will not come back.

This is not hyperbole or exaggeration. The future is unfolding now. We have a number of creative ideas and solutions that will move this process forward and deal with many of the problems we face today and in the future.

Our bottom line, Premier?

We want to participate in the process of preserving and improving our health-care system. We want to meet with you and your officials to work together, to find common ground, to restore our comprehensive and preventative health-care system to what it once was.

We are unwilling to be relegated to the sidelines anymore and watch our health-care system fall apart.

Trust and respect would go a long way toward reversing this trend.

Sincerely,

Douglas Mark, MD
President
and the Board of the Coalition of Family Physicians of Ontario

The Coalition of Family Physicians of Ontario, representing front-line providers of health care, is a grassroots organization dedicated to the provision of top quality health care to the people of Ontario . We strive to protect the rights, freedoms and independence of family physicians of Ontario and to continually improve the health-care system.

Contact:
Stephen Skyvington
Vice President
PoliTrain Inc.
Phone: (416) 985-2239
E-Mail: politrain@aol.com